In this retrospective, interventional case series, researchers looked at pediatric patients (aged ≤14 years) with keratoconus and poor corrected distance visual acuity who underwent intracorneal ring segment implantation and cross-linking. ICRS were inserted under topical anesthesia after creating a corneal tunnel with a femtosecond laser. Cross-linking was performed one month later. Records were reviewed and data collected preoperatively and at six months, one year, two years and four years postoperatively.

Twelve patients (17 eyes; 10 male, two female) aged 9 to 14 years received ICRS implantation followed by CXL. Follow-up times ranged from six months to four years after surgery. At the six-month follow-up all eyes were evaluated; at the one-year, two-year, and four-year follow-ups 11, 10, and seven eyes were evaluated, respectively. At the six-month follow-up, mean CDVA in comparison to preoperative levels improved significantly (p=0.001) from 20/40 to 20/25; mean uncorrected distance visual acuity also improved significantly from 20/160 to 20/50. A significant decrease in both keratometry readings and spherical equivalent (from -4 to -1.56 D) was also noted after ICRS insertion. At the one-year, two-year and four-year follow-ups, refractive values remained relatively stable in comparison to the six-month follow-up, except for a minor but significant improvement in cylinder and, at four years, in UDVA. All patients tolerated the surgery well and no intraoperative or postoperative complications were reported, except for one ring segment that had to be removed after two years due to vascularization and corneal thinning.

According to the results of this study, ICRS implantation with cross-linking is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.

Am J Ophthalmol 2017;178:51-57
^{Abdelmassih Y, El-Khoury S, Dirani A, et al.}

Femtosecond Laser-Enabled vs. Manual Descemetorhexis
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Researchers from Toronto, Canada, introduced a novel method for performing decemetorhexis in Descemet’s membrane endothelial deratoplasty using the femtosecond laser and compared it with DMEK performed with manual decemetorhexis.

They performed a retrospective medical chart review of two groups of patients who underwent DMEK surgery combined with cataract surgery secondary to Fuchs corneal endothelial dystrophy and cataract: 17 patients underwent femtosecond-laser-enabled descemetorhexis DMEK and 89 patients underwent DMEK surgery with manual DMEK. Best spectacle-corrected visual acuity, endothelial cell density, graft detachment rate and complications were compared.

Average age of the 106 patients (64 women and 42 men) was 68 ±11 years. Postoperative best spectacle-corrected visual acuity was 0.19 ±0.13 logarithm of the minimum angle of resolution in the FE-DMEK group and 0.35 ±0.48 LogMAR in the M-DMEK group (p=0.218). One day after surgery, there were no significant graft detachments in the FE-DMEK group, compared with  a 20-percent graft detachment rate in the M-DMEK group (p=0.041). Rebubbling was performed in 17 percent of eyes in the M-DMEK group compared with none in the FE-DMEK group (p=0.066). The mean endothelial cell count in the FE-DMEK and M-DMEK groups at six months after surgery was 2,105 ±285 cells/mm2 (24 percent cell loss) and 1,990 ±600 cells/mm2 (29 percent cell loss), respectively (p=0.579).

Researchers say these results demonstrate that FE-DMEK shows efficacy similar to that of M-DMEK, with apparently less graft detachment and reduced need for rebubbling.

Cornea 2017;36:767-770
^{Einan-Lifshitz A, Sorkin N, Boutin T, Showtail M, et al.}